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© 2022 JETIR May 2022, Volume 9, Issue 5 www.jetir.org (ISSN-2349-5162)

JETIR2205722 Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org g198

A STUDY TO EVALUATE THE

EFFECTIVENESS OF SELECTED PLAY

ACTIVITIES ON LEVEL OF ANXIETY

AMONG HOSPITALIZED PRE-SCHOOL

CHILDREN AT SELECTED HOSPITALS

BANGALORE.

Mr.B.RAJESH M.Sc (N), Asst.professor, Teerthanker Mahaveer University, Moradabad,Uttar

Pradesh.

Mrs. KANJUGAM JIBANLATA DEVI M.Sc (N), PG Tutor, Teerthanker Mahaveer University,

Moradabad,Uttar Pradesh.

ABSTRACT

The study was aimed to evaluate the effectiveness of selected play material on level of anxiety among

hospitalized preschool children at selected Hospitals Bangalore.The research design selected for the present

study was post-test only design group. It is a Quasi-experimental study.Non probability purposive

sampling techniques was adapted for the study. A sample of 60 Preschool children,3 to 6 years of age

group were selected for this study and FLACC behavioural scale was used to assess the level of anxiety .

The results says in the post test experimental group, majority of the subjects 14(46.7) had anxiety score

between (1-3) mild anxiety in experimental group and 25 (83.3) had score (7-10) severe anxiety in control

group. In comparison of the experimental and control group, the overall mean 2.77 and standard deviation

was 2.40 where as in the control group the overall mean 4.97 and standard deviation was 2.14. The student

‘t’ test value at p<0.05 was 3.74. So that null hypothesis (h01 ) is rejected and research hypothesis (h1) is

accepted which says that there is a significant difference in mean scores of level of anxiety among pre-

school children during hospitalization between two groups.

Keywords: Effectiveness, Selected Play activities, anxiety, Hospitalization.

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INTRODUCTION

“Anxiety is a thin stream of fear trickling through the mind, if encouraged, it cuts a channel into

which all other thought are drained.”

- Arthur somers roche

The Children are vitals to the nation present and its future. Parents grandparents aunts and uncle are usually

committed to providing every advantage possible to the children in their families and to ensure that they

are healthy and have opportunities, that they need to full fill their potential.1 Play is an integral part of the

hospitalized child’s plan of care. Play offers, the child, an opportunity or creative expression, diversion and

effective coping. In the hospitals a supervised play programme provides warm friendly atmosphere that

will help the child continue o grow and develop. In the larger hospital a child life specialist may co

ordinate the play programme. A place to play, suitable materials and others children to play with are

essential because play is a child way of learning toys materials and equipment and learning tools.2

Illness in child cause fear and anxiety in 4 to 6 years old children, According to parents 83% of preschool

or kindergarten-aged children suffers from different kind of anxiety symptoms related to hospital fear even

after a minor operation in a hospital. Biologically, a child is generally a human between the stages of birth

and puberty. The legal definition of child generally refers to a minor, otherwise known as a person younger

than the age of majority.3

In hospital setting, children often experience anxiety that can be associated with negative emotional and

psychological implications. Anxiety in children with acute and chronic disease is a major public health

problem that has been increasing over the last 20 years. Hospitalized children required more recreational

play because illness and hospitalization constituate crisis in a child's life and since this situation are fraught

with over whelming stress, children's need to play out their fears and anxieties as a means of coping with

this stress. Play also help temporarily to divert their mind pain and anxeity.3

According to Whaley and Wong's, school children easily distracted even though they have different

temperaments. In order to decrease the anxiety experience during procedures divisional activities in the

form of play, game, radio, video- cassette recorder and television can be used. Cartoon movies are

successful diversion for a child who is hospitalized.4

Play promotes healing and helps the child to cope with stressful experiences. The attitudes and feeling that

children reveals in their play are full of meaning. Every opportunity should be afforded the hospitalized

child to use play and other expensive activities to lessen stress, thus promoting healthy resolution of the

negative aspects of the hospital experiences. The child can find acceptable outlets for hostilities through

play activities.5

The proper selection of toys can provide constructive, educational stimulating , relaxing, divisional, or

therapeutic value. Play is an essential element in the development of healthy individuals; childhood play is

an integral part of the development process in young children. Its occurs spontaneously in children and




gives then an important medium for informal learning play is not a purposeless activity serving only to pass

the childhood hours, it is a vital factor in intellectual, social, and emotional development of a child6.

The way a child naturally express himself\herself is through their play. Often we find that the child who is

confronted with a major life adjustment. Play therapy is designed to help children grow up as happy and

well adjusted as possible.7

Play for most hospitalized children centres around self and stressful situations as perceived by the child and

is restricted in terms of what the environment and physical limitations of the child present. One who had an

expert knowledge of children and play equipment is useful to plan purposeful play programs or play

sessions fir the special needs of hospitalized children. Such collaboration will insure that play will be

carried out in a consistent growth-promoting manner. For some children, hospitalization is a challenging

experience that promotes a sense of competence. For other children, hospitalization is an experience that

results in a negative outcomes. Nurse can use play to provide paediatric patients with emotional and

cognitive growth-promoting activities which facilitate a more positive hospital experience and long- term

outcome.22

Several studies have shown that therapeutic play is effective in decreasing anxiety and fears for children

from the time of admission to immediately after surgery and to the time of discharge. Accordingly, in

studies where children were preferred therapeutic play, they exhibited greater co-operation during stressful

procedure and were more willing to return to the hospitals for further treatment.

Hence, the investigator keeping the above view felt that the selected play therapy will help the children

to be more comfortable in hospital environment.

MATERIALS AND METHODS

The quantitative research approach was adopted in this study. Non – probability purposive sampling

technique was adopted in selecting samples (n=60). The tool used for the study is standard scale,It is

organized as Section I- Socio demographic data, Section II- FLACC Scale was used as a tool to assess the

level of anxiety among children who are admitted. This tool includes five categories of pain bahaviour ,

including facial expression, leg movement, activity, cry, consolability. Ten experts constituting three

psychiatrists, two psychologists and five mental health nursing personnel were validated the Tool.

The Karl Pearson Co-efficient correlation method was used to check Reliability. 10% of the samples

obtained subject for reliability co efficient using Split Half method considering the Karl Pearson’s co

efficient formula. The computed reliability coefficient of the tool found to be 0.9443 which is higher than

the standard value of 0.07.Hence the tool considered found to be most reliable and take for conducting the

main study.. The data was analyzed by using descriptive and inferential statistics.




RESULTS

SECTION1: : OVER ALL AND ASPECT WISE BEHAVIOURAL ANXEITY LEVEL AMONG

EXPERIMENTAL AND CONTROL GROUP OF PRESCHOOL CHILDREN

TABLE-1

Table 1: Experimental group level of anxiety

N=60

Level of Anxiety

Experiment group

No. of children %

Relaxed and comfortable 8 26.67%

Mild anxiety 12 40.00%

Moderate anxiety 8 26.67%

Severe anxiety 2 6.66%

Total 30 100.00%

The above table, shows in the post test experimental group, majority of the children 26.67% are having

Relaxed and comfortable level of score, 40.00% are having mild anxiety level ,26.67% of them are having

moderate anxiety level, 6.66% are having severe level of anxiety.

GRAPH 1: EXPERIMENTAL GROUP LEVEL OF ANXEITY

26.67%

40.00%

26.67%

6.66%

-10%

0%

10%

20%

30%

40%

50%

60%

Relaxed andcomfortable

Mild anxiety Moderate anxiety Severe anxiety

% o

f ch

ildre

n

EXPERIMENT GROUP LEVEL OF ANXIETY




Table- 2

Table -2 Control group level of anxiety

N=60

Level of Anxiety

Control group

No. of children %

Relaxed and comfortable 2 6.67%

Mild anxiety 4 13.33%

Moderate anxiety 18 60.00%

Severe anxiety 6 20.00%

Total 30 100.00%

The above table, shows in the post test control group,6.67% are having Relaxed and comfortable level of

score, 13.33% are having mild anxiety level ,60.00% of them are having moderate anxiety level, 20.00%

are having severe anxiety level .

GRAPH 2: CONTROL GROUP LEVEL OF ANXEITY

6.67%13.33%

60.00%

20.00%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Relaxed andcomfortable

Mild anxiety Moderate anxiety Severe anxiety

% o

f ch

ildre

n

CONTROL GROUP LEVEL OF ANXIETY




TABLE- 3

Table-3 COMPARISON OF LEVEL OF ANXIETY AMONG PRESCHOOL

CHILDREN

N=60

Level of anxiety

Respondents Chi square test

Experiment Control

n % n %

Relaxed and

comfortable 8 26.67% 2 6.67%

2=12.52 P=0.01**(S)

Mild anxiety 12 40.00% 4 13.33%

Moderate anxiety 8 26.67% 18 60.00%

Severe anxiety 2 6.66% 6 20.00%

Total 30 100.00% 30 100.00%

The above table shows the comparision the level of anxiety experienced by preschool children during

hospitalization in experimental and control group by using FLACC behavioural anxiety scale.

In experiment, 26.67% are having Relaxed and comfortable level of score, 40.00% are having mild

anxiety level , 26.67% of them are having moderate anxiety level, 6.66% are having severe anxiety level

In control, 6.67% are having Relaxed and comfortable level of score, 13.33% are having mild anxiety

level , 60.00% of them are having moderate anxiety level, 20.00% are having severe anxiety level. There is

a significant difference between Experiment and Control group. It was assessed by using chi square test.

TABLE- 4

Table-4 COMPARISON OF MEAN ANXIETY SCORE BETWEEN EXPERIMENT AND

CONTROL GROUP OF PRESCHOOL CHILDREN N=60

Group No. of

children

Anxiety

Mean±

SD

Mean

difference

Mean± SD

Student’s independent

t-test

Experiment 30 2.77 ±

2.40

2.20 t=3.74 P=0.005***

DF = 59, significant Control 30 4.97 ±

2.14




*** very high significant at P≤0.005

Inference.:

The calculated value of children t-test came out to be 2.77, which was more than the table value at 0.05

levels i.e.,1.96. So that null hypothesis (H01) is rejected and research hypothesis is accepted which says that

there was a significant difference between in anxiety level among experimental and control group.

Graph-3: BOX-PLOT compares the anxiety score between experiment and control group of pre-school

children.




TABLE- 5

Table-5 EFFECTIVENESS AND GENERALIZATION OF PLAY ACTIVITY

N=60

Max

score

Mean

score

% of mean

score

Mean

Difference of

anxiety score

with 95%

Confidence

interval

Percentage Difference

of anxiety score with

95% Confidence

interval

Experiment 10 2.77 27.7% 2.20(1.02 – 3.37) 22.0%(10.2% –33.7%)

Control 10 4.97 49.7%

The experiment group children are having 22% less than control group children anxiety score. This

difference shows the effectiveness selected play activities on level of anxiety among the hospitalized pre-

school children by comparing the experimental and control group.

Differences and generalization of play activity score between experimental and control group score was

calculated using and mean difference with 95% CI and proportion with 95% CI. In this study

effectiveness of the study is point estimate of 22.00% and interval estimate is 10.2% to 33. 7%. It means in

this similar setup of the study, whom ever conducted , 95 % we can assure , effectiveness of the study will

lies between 10.2% to 33. 7% anxiety score reduction.




SECTION-II

Section-II: Association between demographic variables and behavioural anxiety level among

experimental and control group of preschool children.

TABLE-6

Table -6 Association between level of anxiety and demographic variables (experiment) group

N=60

Demographic variables

Level of anxiety Sa

mpl

e(N

)

Chi square

test Relaxed

and

comfortable

Mild

anxiety

Moderate

anxiety

Severe

anxiety

N % N % N % N %

Age 3yrs 4 44.4 4 44.4 1 11.2 0 0.0 9 2=19.59P=0.0

5*(NS) 4yrs 4 28.6 5 35.7 5 35.7 0 0.0 14

5yrs 0 0.0 2 50.0 2 50.0 0 0.0 4

6yrs 0 0.0 1 33.3 0 0.0 2 66.7 3

Gender Male 8 72.7 0 0.0 3 27.3 0 0.0 11 2=3.42

P=0.33 (NS) Female 0 0.0 12 63.2 5 26.3 2 10.5 19

Education

status

Play

group 4 57.1% 3

42.9

% 0 0.0% 0 0.0% 7

2=35.05

P=0.05* (S)

Nursery 4 33.3% 6

50.0

% 2 16.7% 0 0.0% 12

LKG 0 0.0% 3

33.4

% 6 66.6% 0 0.0% 9

UKG 0 0.0% 0 0.0% 0 0.0% 2

100.0

% 2

Religion Hindu 4 44.4% 3

33.3

% 2 22.3% 1

11.1

% 9

2=2.39

P=0.08 (NS)

Muslim 2 20.0% 4

40.0

% 3 30.0% 1

10.0

% 10




Christian 2 18.3% 4

36.4

% 3 27.3% 0 0.0% 11

Type of family Nuclear 4 33.3% 5

41.7

% 3 25.0% 0 0.0% 12

2=1.03

P=0.79 (NS)

Joint 0 0.0% 7

50.0

% 5 35.7% 2

14.3

% 14

Others 4 100.0% 0 0.0% 0 0.0% 0 0.0% 4

No.of siblings None 3 33.3% 4

44.5

% 1 11.1% 1

11.1

% 9

2=10.45P=0.3

2(NS)

One 2 18.2% 7

63.6

% 2 18.2% 0 0.0% 11

Two 2 22.2% 1

11.1

% 5 55.6% 1

11.1

% 9

three or

more 1 100.0% 0 0.0% 0 0.0% 0 0.0% 1

care giver of

child

Mother 8 72.7% 0 0.0% 3 27.3% 0 0.0% 11 2=13.31

P=0.05* (S) Father 0 0.0% 7

58.3

% 3 25.0% 2 0.0% 12

Grandpar

ents 0 0.0% 5

71.4

% 2 28.6% 0 0.0% 7

child admission

status

Stable 8 57.1% 3

21.4

% 3 21.4% 0 0.0% 14

2=13.42

P=0.01** (S)

Sick 0 0.0% 9

56.3

% 5 31.3% 2

12.5

% 16

previous history

of

hospitalisation

Yes 4 28.5% 7

50.0

% 3 21.5% 0 0.0% 14

2=1.77

P=0.62 (NS)

No 4 25.0% 5

31.3

% 5 31.3% 2

12.5

% 16

immunisation

status

Complete 5 29.4% 8

47.1

% 4 23.5% 0 0.0% 17

2=2.22

P=0.53 (NS)

Incomplet

e 3 17.9% 4

30.8

% 4 30.8% 2

15.4

% 13

*Significant at 5% level, NS:Non- Significant

To determine the association between demographic variables and behavioural anxiety level of

experiment group among pre school children with their selected socio-demographic variables null

hypothesis (H02 )was developed i.e., there is no significant association on level of anxiety among pre




school children during hospitalization with selected socio demographic variables of experimental

group.

The level of significance was set at 0.05 levels.In order to determine association between demographic

variables and behavioural anxiety level with their selected demographic variables the chi-square test (x2)

was computed.

TABLE- 7

Table -7 Association between level of anxiety and demographic variables (control) group

N=60

Demographic variables

Level of anxiety Sam

ple

(N)

chi square test

Relaxed and

comfortable Mild anxiety

Moderate

anxiety

Severe

anxiety

N % N % N % N %

Age 3yrs 1 8.3 2 16.7 8 66.7 1 8.3 12 2=9.41P=0.4

0(NS) 4yrs 0 0.0 0 0.0 9 81.8 2 18.2 11

5yrs 1 25.0 1 25.0 1 25.0 1 25.0 4

6 yrs 0 0.0 1 33.3 0 0.0 2 66.7 3

Gender Male 1 7.7 1 7.7 5 38.5 6 46.2 13 2=6.80

P=0.08 (NS) Female 1 5.9 3 17.6 13 76.5 0 0.0 17

Education status Play

group 1 16.7 2 33.3 3 50.0 0 0.0 6

2=11.20

P=0.26 (NS)

Nurser

y 0 0.0 1 7.7 10 76.9 2 15.3 13

LKG 1 14.3 0 0.0 5 71.4 1 14.3 7

UKG 0 0.0 1 25.0 0 0.0 3 75.0 4

Religion Hindu 1 9.1 3 27.3 7 63.6 0 0.0 11 2=9.10




*Significant at 5% level NS: Non-Significant

Musli

m 0 0.0 0 0.0 6

100.

0 0 0.0 6

P=0.09 (NS)

Christi

an 1 7.7 1 7.7 5 38.5 6 46.2 13

Type of family Nuclea

r 0 0.0 0 0.0 13 81.3 3 18.7 16

2=11.78

P=0.07 (NS)

Joint 1 9.1 2 18. 5 45. 3 27.2 11

Others 1 33.3 2 66.7 0 0.0 0 0.0 3

No.of siblings None 2 33.3 2 33.3 2 33.4 0 0.0 6 2=12.98P=0.

16(NS) One 0 0.0 0 0.0 11 78.6 3 21.4 14

Two 0 0.0 2 25.0 3 37.5 3 37.5 8

three

or

more

0 0.0 0 0.0 2 100.

0 0 0.0 2

care giver of child Mother 0 0.0 4 36.4 7 63. 0 0.0 14 2=10.15

P=0.10 (NS) Father 2 16.7 0 0.0 8 66.7 2 16.7 10

Grandp

arents 0 0.0 0 0.0 3 42.9 4 57.1 6

child admission

status

Stable 1 6.3 3 18.7 12 75.0 0 0.0 16 2=5.70

P=0.12 (NS) Sick 1 7.1 1 7.1 6 42.9 6 42.9 14

previous history

of hospitalisation

Yes 1 9.1 3 27.3 7 63.6 0 0.0 11 2=3.99

P=0.26 (NS) No 1 5.3 1 5.3 11 57.9 6 31.7 19

immunisation

status

Compl

ete 0 0.0 4 26.7 10 66.7 1 6.6 15

2=5.88

P=0.12 (NS)

Incomp

lete 2 13.3 0 0.0 8 53.3 5 33.3 15




To determine the association between demographic variables and behavioural anxiety level of

experiment group among preschool children with their selected socio-demographic variables null

hypothesis (H02 )was developed i.e., there is no significant association on level of anxiety among pre -

school children during hospitalization with selected socio demographic variables of experimental

group.

The level of significance was set at 0.05 levels. In order to determine association between demographic

variables and behavioural anxiety level with their selected demographic variables the chi-square test (x)

was computed.

DISCUSSION:

In the post test experimental group, majority of the subjects 14(46.7) had anxiety score between (1-3)

mild anxiety in experimental group and 25 (83.3) had score (7-10) severe anxiety in control group.

In comparison of the experimental and control group, the overall mean 2.77 and standard deviation was

2.40 where as in the control group the overall mean 4.97 and standard deviation was 2.14. The student

‘t’ test value at p<0.05 was 3.74. So that null hypothesis (h01 ) is rejected and research hypothesis (h1) is

accepted which says that there is a significant difference in mean scores of level of anxiety among pre-

school children during hospitalization between two groups.

When an association between demographic variables and behavioural anxiety level among experimental

and control group is considered, there was statistically significant association found with socio

demographic variables age( x=14.81*, d f=2) gender (x=7.55*,d f=2), history of previous hospitalization

(x= 9.11*,d f=2) in experimental group; gender (x=6.86*,d f=2),type of family (x= 7.85 *,d f=2)in control

group. Hence, null hypothesis no association between demographic variables and behavioural anxiety level

among experimental and control group is rejected. The research hypothesis H2,”There was a significant

association on behavioural anxiety level among pre-school children during hospitalization with

selected socio-demographic variable of experimental and control group.” is accepted.

CONCLUSION

The present study was conducted to evaluate the effectiveness of selected play activities on level of

anxiety among preschool children at selected hospital in Bangalore. The sample were allotted to two

groups-experimental and control with 30 sample each. The sample in the experimental group received the

intervention of selected play activities and sample in control group received no intervention.

The finding s of the study in post test showed that, the majority of the subject,25 ( 83.3% )had score

(7-10)severe discomfort in control group and 14(46.7% ) in the experimental group had anxiety score

(1-3) mild discomfort.

When the comparision of behavioural pain among experimental and control group, the calculated

value of student t-test came out to be 2.79,which was more than the table value at 0.05 levels i.e.,




.Hence, null hypothesis (H01) is rejected and research hypothesis (H1) is accepted which says

that there was a significant difference in mean score of behavioural anxiety level among pre-

school children during hospitalization between experimental and control group.

When an association between demographic variables and behavioural anxiety level among

experimental and control group is considered, there was statistically significant association found

with socio demographic variables age( x=14.81*, d f=2) gender (x=7.55*,d f=2), history of previous

hospitalization (x= 9.11*,d f=2) in experimental group; gender (x=6.86*,d f=2),type of family (x=

7.85 *,d f=2)in control group. Hence, null hypothesis no association between demographic variables

and behavioural anxiety level among experimental and control group is rejected. The research

hypothesis H2,”There was a significant association on behavioural anxiety level among pre-

school children during hospitalization with selected socio-demographic variable of experimental

and control group.” is accepted.

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http://en.wikipedia.org/%20wiki/%20learning

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